Ⅳ期神经母细胞瘤手术切除范围对生存率的影响

The impact of surgical intervention on survival in stage IV neuroblastoma

目的探讨手术切除范围对Ⅳ期神经母细胞瘤生存率的影响。方法回顾性分析天津医科大学附属肿瘤医院2002年12月至2010年12月确诊的Ⅳ期神经母细胞瘤患儿59例，其中未接受手术切除肿瘤原发灶的17例，不完整切除的9例，完整肉眼切除的33例，其中有镜下残留的10例，无镜下残留的23例。结果59例有随访资料中的Ⅳ期NB患儿中位生存时间23个月（1～96个月），中位就诊年龄为41个月（13～118个月），术前化疗有效率为87．5％，手术完整切除率为68．8％。2年生存率未接受原发灶切除组的为14．2%，不完整切除组44．4％，完整肉眼切除组54．2％。Kaplan-Meier生存曲线提示未接受原发灶切除组（中位生存期10个月）低于不完整切除（中位生存期24个月）和完整肉眼切除组（中位生存期33个月）。Log-rank检验显示未接受原发灶切除组与接受原发灶部完整肉眼切除组的生存曲线差异有统计学意义（P〈0．000），未接受原发灶切除组与不完整切除组的生存曲线差异有统计学意义（P=0．002）。在完整肉眼切除组中，Kaplan-Meier生存曲线未提示无镜下残留组（中位生存期33个月）高于有镜下残留组（中位生存期22个月），Log-rank检验显示无统计学意义（P=0．593）。结论术前化疗能提高Ⅳ期NB患儿的手术完整切除率，在完整切除原发灶后，有无镜下残留并不影响生存率的提高。在术前化疗有效控制转移灶的情况下，可尽量行原发灶完整切除术。

Objective The implications of surgical intervention for neuroblastoma of stage IV were assessed. Methods We analyzed the clinical characteristics and extent of resection in 59 pediatric patients who were diagnosed neuroblastoma stage 1V and had complete follow-up data between 2002 and 2010 in the Cancer Institute and Hospital of Tianjin Medical University. There were 17 cases whose parents did not agree to the resection of the primary tumor and 9 cases who accepted subtotal resection. 33 cases had complete gross resection, including 10 cases who had macroscopic residue and 23 cases who had microscopic clear margirL Results The median overall survival time of the 59 pa- tients with the follow-up data was 23 months （CI.- 1-96 months）. The median age of these patients was 41 months （CI.- 13-118 months）. The effective rate of induction chemotherapy was 87. 5 ~ and the rate of complete resection was 68. 8%. The 2 -year survival rate in the no surgery group was 14. 2 %, and in the subtotal resection group was 44. 4%and in the Kaplan-Meier curve showed that no surgery group complete resection group was 54. 2% respectively. （Median survival 10 months） had a lower survival rate than the subtotal resection group （Median survival 24 months） and the complete resection group （Median survival 33 months）. Log-rank test showed significant statistical difference between no surgery group and the complete resection group （P〈0. 000） and also was seen between no surgery group and the subtotal resection group （P = 0. 002）. Kaplan-Meier curves showed that in the complete resection group , the microscopic clear margin group （Median survival 33 months） did not have a higher survival rate than the microscopic residual group （ Median survival 22 months）o No statistical difference was seen between the two groups（P = 0. 593）. Conclusions Induction chemotherapy can improve the complete resection rate of neuroblastoma stage IV. When complete resection was the intention,there is no difference of the survival rate whether there is microscopic clear margin or not.